Holocene climatic variability indicated by a multi-proxy record from southern Africa's highest wetland

The eastern Lesotho Highlands experience climate patterns distinct from those of surrounding lower altitude regions, representing a niche environment with a unique biodiversity, leading to well-adapted but restricted vegetation. This study explores changes in the Holocene composition of diatoms and pollen at southern Africa’s highest altitude wetland (Mafadi: 3390 m a.s.l.). The palaeoenvironmental record for Mafadi Wetland indicates fluctuations between cold, wet conditions, prevalent between ~8140 and 7580 cal. yr BP and between ~5500 and 1100 cal. yr BP, and warmer, drier periods between ~7520 and 6680 cal. yr BP and between ~6160 and 5700 cal. yr BP. Marked climatic variability is noted from ~1100 cal. yr BP with colder conditions at ~150 kyr BP. Notably, the first of these cold periods occurs soon after the Northern Hemisphere 8.2 kyr event, while a second period of notably cold conditions occurs around 1100 cal. yr BP. Variability exists between the moisture reconstructions presented in this study and those from adjacent lower altitude sites, which is hypothesised to reflect variations in the strength and extent of the Westerlies throughout the Holocene

A multi-proxy analysis of late Quaternary palaeoenvironments, Sekhokong Range, eastern Lesotho

The eastern Lesotho Highlands host an array of periglacial and glacial geomorphic features. Their analysis has provided past climate interpretations predominantly for cold periods, yet no multi-proxy temporally continuous palaeoenvironmental records exist. This study presents a palaeoenvironmental reconstruction based on sedimentary characteristics, fossil pollen and diatoms from an alpine wetland located in the Sekhokong Mountain Range. The record commences in the late Pleistocene with a wet period from ∼16 450 to 14 440 cal a BP, interrupted by dry conditions from ∼16 350 to 15 870 cal a BP. From ∼14 150 to 8560 cal a BP, drier conditions are inferred, slowly transitioning to warmer, wetter conditions. Warmer, dry conditions are inferred for ∼8560–7430 cal a BP, followed by cold, wet conditions from ∼7280 to 6560 cal a BP. A dry, warmer period occurs from ∼6560 to 3640 cal a BP indicated by pollen, diatom and sedimentary records, followed by cool, wet conditions from ∼3400 to 1200 cal a BP. The period from ∼1110 cal a BP to the present is characterized by progressive drying. Pronounced cold events are detected from the diatom record. Moisture records appear relatively specific to the topographic setting of Sekhokong near the Great Escarpment edge, probably driven by orographically constrained synoptic controls

Chrysocoma ciliata L. (Asteraceae) in the Lesotho Highlands: an anthropogenically introduced invasive or a niche coloniser?

Over recent decades, concern has been raised regarding the management of Chrysocoma ciliata L. (Asteraceae syn. C. tenuifolia) in the eastern Lesotho Highlands. This shrub species is argued to be a Karroid invasive introduced anthropogenically within the last century. Historical botanical records in Lesotho are scarce, so the origins of this species in the region are as yet uncertain. Speculation is based on the contemporary abundance of these shrubs in overgrazed areas throughout the highlands. This study presents fossil pollen records for the eastern Lesotho Highlands which confirm the presence of this species intermittently throughout the past ~6000 cal yr BP. In so doing, this study refutes claims that the species was introduced anthropogenically within the past 100 years, and of its narrow definition as a Karoo species invasive in Lesotho. The intermittent appearance of this species in the pollen record, however, indicates that it is climate sensitive, colonising the wetlands under conditions unsuitable to other plant species. Evidence presented here calls for a re-evaluation of the categorisation of C. ciliata as an invasive in the Lesotho Highlands, and more critically, for a redevelopment of the environmental management policies which involve this species

Late Quaternary research in southern Africa: progress, challenges and future trajectories

Southern African late Quaternary research has developed rapidly during recent decades, with an increase in the range of proxies used, the inclusion of new field sites, and increased international collaboration and skills transfer. This has enabled recent meta-studies into the synoptic drivers of palaeoenvironmental shifts across the region, and of spatial variability in climatic and environmental changes. Expanded research has also highlighted uncertainties in the understanding of southern African palaeoenvironments, and the relationships with Northern Hemisphere analogues, encouraging on-going critical debate within the discipline. Given current concerns of climate change impacts on the natural environment, the spread of invasives, increased fire frequency, and anthropogenic influences on the natural environment, palaeoenvironmental data and inferences are increasingly being utilised outside of the palaeoenvironmental discipline, providing a valuable inter-disciplinary platform for global change science in the region. Relative to the size, landscape and climatic heterogeneity and resultant biome variability across southern Africa, the network of palaeoenvironmental study sites remains sparse, and arguably insufficient to resolve key debates. This paper critically reviews these spatial gaps in palaeoenvironmental knowledge, with a particular emphasis on the shortfalls of the current network of study sites and palaeoenvironmental records in resolving debates concerning latitudinal shifts of the Westerlies, conditions during the last glacial maximum and contemporaneous Northern and Southern Hemisphere climatic events. Southern African applications of palaeoenvironmental science in exploring ecological trait shifts, fire influences and anthropogenic impacts are briefly discussed, to facilitate the future identification of key sites, proxies, debates and applications in ongoing regional Quaternary work

A trial platform to develop a tailored theory-based intervention to improve professional practice in the disclosure of a diagnosis of dementia: Study protocol [ISRCTN15871014]

BACKGROUND: For people with dementia, care should include an explanation of the diagnosis to individuals and their carers, and information about the likely prognosis and possible packages of care. However, this is neither routine nor inevitable, and there is wide variation in the practice of disclosure. The aim of this study is to develop a tailored theory-based intervention to promote appropriate disclosure of diagnosis of dementia. METHODS: There are three objectives. Objective 1 is to define and develop an appropriate model of disclosure; this will be addressed using a multidisciplinary consensus development process. Objective 2 is to identify factors that influence disclosure of diagnosis; a questionnaire based upon theoretical constructs from a range of behavioural theories will be developed and members of old age mental health teams will be surveyed. The analysis will identify those factors that best predict intention to disclose a diagnosis to a person with dementia. Objective 3 is to develop and pilot test a theory-based intervention to promote disclosure of diagnosis that targets attitudes, beliefs and actions most amenable to change. Objective 3 will use the results of Objectives 1&2 to design and pilot test an intervention to improve the process of and increase the proportion of individuals receiving a diagnosis of dementia, for members of old age mental health teams. This work will lead to a proposal for a randomised controlled trial of the intervention

Anterior interosseous nerve syndrome: retrospective analysis of 14 patients

Introduction: The anterior interosseous nerve (AIN) is a only motor nerve innervating the deep muscles of the forearm. Its compression is rare. We present a retrospective analysis of 14 patients with an AIN syndrome with a variety of clinical manifestations who underwent operative and conservative treatment. Patients and methods: Fourteen patients (six female, eight male, mean age 48 ± 9 years) were included. In six patients, the right limb was affected, and in eight patients the left limb. Conservative treatment was started for every patient. If no signs of recovery appeared within 3 months, operative exploration was performed. Final assessment was performed between 2 and 9 years after the onset of paralysis (mean duration of follow-up 46 ± 11 months). Patients were examined clinically for return of power, range of motion, pinch and grip strengths. Also the disability of the arm, shoulder, and hand (DASH) score was calculated. Results: Seven of our 14 patients had incomplete AIN palsy with isolated total loss of function of flexor pollicis longus (FPL), five of FPL and flexor digitorum profundus (FDP)1 simultaneously, and two of FDP1. Weakness of FDP2 could be seen in four patients. Pronator teres was paralysed in two patients. Pain in the forearm was present in nine patients. Four patients had predisposing factors. Eight patients treated conservatively exhibited spontaneous recovery from their paralysis during 3-12 months after the onset. In six patients, the AIN was explored 12 weeks after the initial symptoms and released from compressing structures. Thirteen patients showed good limb function. In one patient with poor result a tendon transfer was necessary. The DASH score of patients treated conservatively and operatively presented no significant difference. Conclusion: AIN syndrome can have different clinical manifestations. If no signs of spontaneous recovery appear within 12 weeks, operative treatment should be performed

Study design and methods of the BoTULS trial: a randomised controlled trial to evaluate the clinical effect and cost effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A

Background Following a stroke, 55–75% of patients experience upper limb problems in the longer term. Upper limb spasticity may cause pain, deformity and reduced function, affecting mood and independence. Botulinum toxin is used increasingly to treat focal spasticity, but its impact on upper limb function after stroke is unclear. The aim of this study is to evaluate the clinical and cost effectiveness of botulinum toxin type A plus an upper limb therapy programme in the treatment of post stroke upper limb spasticity. Methods Trial design : A multi-centre open label parallel group randomised controlled trial and economic evaluation. Participants : Adults with upper limb spasticity at the shoulder, elbow, wrist or hand and reduced upper limb function due to stroke more than 1 month previously. Interventions : Botulinum toxin type A plus upper limb therapy (intervention group) or upper limb therapy alone (control group). Outcomes : Outcome assessments are undertaken at 1, 3 and 12 months. The primary outcome is upper limb function one month after study entry measured by the Action Research Arm Test (ARAT). Secondary outcomes include: spasticity (Modified Ashworth Scale); grip strength; dexterity (Nine Hole Peg Test); disability (Barthel Activities of Daily Living Index); quality of life (Stroke Impact Scale, Euroqol EQ-5D) and attainment of patient-selected goals (Canadian Occupational Performance Measure). Health and social services resource use, adverse events, use of other antispasticity treatments and patient views on the treatment will be compared. Participants are clinically reassessed at 3, 6 and 9 months to determine the need for repeat botulinum toxin type A and/or therapy. Randomisation : A web based central independent randomisation service. Blinding : Outcome assessments are undertaken by an assessor who is blinded to the randomisation group. Sample size : 332 participants provide 80% power to detect a 15% difference in treatment successes between intervention and control groups. Treatment success is defined as improvement of 3 points for those with a baseline ARAT of 0–3 and 6 points for those with ARAT of 4–56

Thioredoxin-binding protein-2 (TBP-2/VDUP1/TXNIP) regulates T-cell sensitivity to glucocorticoid during HTLV-I-induced transformation

Although glucocorticoid (GC) is widely used for treating hematopoietic malignancies including adult T-cell leukemia (ATL), the mechanism by which leukemic cells become resistant to GC in the clinical course remains unclear. Using a series of T-cell lines infected with human T lymphotropic virus type-I (HTLV-I), the causative virus of ATL, we have dissected the transformation from interleukin (IL)-2-dependent to -independent growth stage. The transformation associates the loss of thioredoxin-binding protein-2 (TBP-2), a tumor suppressor and regulator of lipid metabolism. Here we show that TBP-2 is responsible for GC-induced apoptosis in ATL cells. In the IL-2-dependent stage, dexamethasone induced TBP-2 expression and apoptosis, both of which were blocked by GC receptor (GR) antagonist RU486. Knockdown of TBP-2 consistently reduced the amount of GC-induced apoptosis. In IL-2-independent stage, however, expression of GR and TBP-2 was suppressed and GC failed to induce apoptosis. Forced expression of GR led the cells to mild sensitivity to GC, which was also accomplished by treatment with suberoylanilide hydroxamic acid, a TBP-2 inducer. A transfection experiment showed that TBP-2 expression induced apoptosis in IL-2-independent ATL cells. Thus, TBP-2 is likely to be one of the key molecules for GC-induced apoptosis and a potential target for treating the advanced stage of ATL

Application of Diffusion Tensor Imaging Parameters to Detect Change in Longitudinal Studies in Cerebral Small Vessel Disease.

Cerebral small vessel disease (SVD) is the major cause of vascular cognitive impairment, resulting in significant disability and reduced quality of life. Cognitive tests have been shown to be insensitive to change in longitudinal studies and, therefore, sensitive surrogate markers are needed to monitor disease progression and assess treatment effects in clinical trials. Diffusion tensor imaging (DTI) is thought to offer great potential in this regard. Sensitivity of the various parameters that can be derived from DTI is however unknown. We aimed to evaluate the differential sensitivity of DTI markers to detect SVD progression, and to estimate sample sizes required to assess therapeutic interventions aimed at halting decline based on DTI data. We investigated 99 patients with symptomatic SVD, defined as clinical lacunar syndrome with MRI confirmation of a corresponding infarct as well as confluent white matter hyperintensities over a 3 year follow-up period. We evaluated change in DTI histogram parameters using linear mixed effect models and calculated sample size estimates. Over a three-year follow-up period we observed a decline in fractional anisotropy and increase in diffusivity in white matter tissue and most parameters changed significantly. Mean diffusivity peak height was the most sensitive marker for SVD progression as it had the smallest sample size estimate. This suggests disease progression can be monitored sensitively using DTI histogram analysis and confirms DTI's potential as surrogate marker for SVD

Relationship between H.Pylori infection and clinicopathological features and prognosis of gastric cancer

<p>Abstract</p> <p>Background</p> <p>Aimed to assess the relationship between H.Pylori and the clinicopathological features and prognosis of gastric cancer by quantitative detection of H.Pylori.</p> <p>Methods</p> <p>157 patients were enrolled, all patients had a record of clinicopathological parameters. Specimens including the tumor and non-neoplastic were detected for H.Pylori by Real-Time PCR and analyzed clinical data retrospectively. Variables independently affecting prognosis were investigated by means of multivariate analysis using the Cox proportional hazards model.</p> <p>Results</p> <p>H.Pylori infection was greater in non-neoplastic tissue than the tumor tissue (p < 0.05), H.Pylori infection and its copies were related to the tumor site and N staging (p < 0.05). Overall survival (OS) in all 157 patients has no correlation with the H.Pylori infection status (p = 0.715). As to the patients who underwent a curative surgery, relapse-free survival (RFS) has no correlation with the H.Pylori infection status (p = 0.639). Among the H.Pylori positive patients, OS and RFS of those with higher copies were longer than in patients with low copies, but there was no significant statistical difference.</p> <p>Conclusions</p> <p>H.Pylori infection status and its copies were related to N staging. The OS and RFS in patients with positive H.Pylori status has no significant difference from the patients with negative H.Pylori status.</p